If there is one thing that these 7 myths tell us, it is that as communication is a shared process, there is an onus on both parties to ensure they have the correct “shared understanding“

courtesy of De Gruyter publishing

I recently read an excellent book called “New Horizons in Patient Safety: Understanding Communication (Hannawa, Wu & Juhasz, De Gruyter) which examines the role that communication plays in patient safety issues through 39 case studies. This excellent book is essential reading for anyone involved in teaching or delivering health care. As a teacher of Leadership & Management and the role that communication plays in these skills, I cannot recommend this book enough.

One of the chapters (by Annegret F Hannawa, Ph.D.) explores common myths about communication. In this blog, I will discuss the 7 myths presented in the book, and add in a Leadership & Management perspective.

Myth 1: Communication is a simple and functional task

Communication is often, incorrectly, conceptualised as a linear task of transferring a message. In fact, it is, as Hannawa describes it “interactive, error prone activity that often fails to accomplish its purpose of attaining a shared understanding”. This has implications not only for patient safety, but also in effective leadership & management, as leaders and managers often assume that “message sent is message received (and understood)”. The only way to confirm accurate communication is for the other person to be able to demonstrate a shared understanding by telling you their understanding. This is equally true in leadership and management situations, as well as HCP-patient communication.

Myth 2: Communication equals words

We’ve all played “Chinese whispers” where a message is passed along a “human chain” of several individuals. This sequential communication process often results in reduction in the quality and quantity of the information conveyed. This can be fun in a parlour game, but has serious consequences for patient safety and in leadership & management situations.

Then there is the impact of “non-verbal” communication. Language is often ambiguous and we “look” to body language and tone of voice to help us put a final interpretation on the meaning or significance of the message.

Myth 3: Communication equals information transfer

The case studies in the book illustrate how communication is more than just the conveying of factual information. The message recipient will have a set of personal filters through which the information must pass. These include personal experience, values, beliefs, cultural and social filters, as well as relationship filters. The relationship between the initiator and the receiver has a massage effect on the understanding (HCP – patient, manager-report)

Myth 4: Communication can be accessed, deposited and delegated

Written communication is subject to the same rules of (mis)understanding as verbal communication. Just because it is written down (deposited) does not guarantee communication. In fact, it may increase the risk of misunderstanding as shared understanding is not guaranteed. Whatever medium is used, it always pays to check that there is shared understanding, not assume that it is obvious.

Myth 5: Communication is not about individual understanding

As Hannawa puts it “Communication is an interpersonal meaning-making process” which occurs between not within people. Yet the assumption is often that everybody has the same understanding of terminology or jargon. This “common ground fallacy” can result not only in patient safety issues, but also management issues. Take the example of setting a timescale for a goal or objective. If I want to a achieve a goal “by December” what date comes to mind? By when does the goal have to be achieved? Write it down. You can choose any date from 30 November to 31 December and be right! That can represent a difference of up to 32 days between two individuals. To ensure shared understanding we need both parties to verbalise and document a specific date.

Myth 6: More communication is better

People tend to assume that more communication is better communication. As Hannawa reminds us though “the truth, however, is that the functional form of the association between communication skills and competence is an inverted U, with both too little and too much of any given behaviour being perceived as inappropriate and ineffective in most healthcare interactions”. There is still a place for structure and repetition, especially in presentations (see relevancy, primacy and recency) but remember; the only difference between a cure and a poison is the dosage!

Myth 7: Communication “breaks down”

Many people describe “failed communication” as a “breakdown” in communication. This perspective “mistakenly implies that communication failure equates to a mere lack of communication rather than incomplete communication” (Hannawa). This has massive implications for organisations as it can perpetuate a “blame culture”, something that is very relevant to patient safety. As Hannawa states in the book “across the 39 case studies. poor outcomes were the result of no established shared understanding. What was never established cannot “break down”.

If there is one thing that these 7 myths tell us, it is that as communication is a shared process, there is an onus on both parties to ensure they have the correct “shared understanding“. For those in positions of responsibility (e.g managers to reports or HCPs to patients) there is increased onus on the initiator of the communication to confirm a shard understanding, not assume it

In the next part of this blog we will explore the Nine Core Principles of Human Communication